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Highly Accessed Open Badges Commentary

Glucocorticoids in sepsis: dissecting facts from fiction

Paul E Marik

Author Affiliations

Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, 825 Fairfax Ave, Suite 410, Norfolk, VA 23507, USA

Critical Care 2011, 15:158  doi:10.1186/cc10101

See related letter by Sprung et al.

Published: 6 May 2011


An intact hypothalamic-pituitary-adrenal (HPA) axis with effective intracellular glucocorticoid anti-inflammatory activity is essential for host survival following exposure to an infectious agent. Glucocorticoids play a major role in regulating the activity of nuclear factorkappa- B, which has a crucial and generalized role in inducing cytokine gene transcription after exposure to an invading pathogen. Severe sepsis is, however, associated with complex alterations of the HPA axis, which may result in decreased production of cortisol as well as glucocorticoid tissue resistance.